Please use this identifier to cite or link to this item:
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: A critical systems evaluation of the introduction of a 'discharge to assess' service in Kent
Author(s): Gadsby, Erica Wirrmann
Wistow, Gerald
Billings, Jenny
Keywords: critical systems heuristics
discharge to assess
hospital discharge
implementation process
integrated care
Issue Date: 6-Jan-2022
Date Deposited: 20-Jan-2022
Citation: Gadsby EW, Wistow G & Billings J (2022) A critical systems evaluation of the introduction of a 'discharge to assess' service in Kent. Critical Social Policy.
Abstract: Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment.
DOI Link: 10.1177/02610183211065028
Rights: This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (
Notes: Output Status: Forthcoming/Available Online
Licence URL(s):

Files in This Item:
File Description SizeFormat 
02610183211065028.pdfFulltext - Published Version815.11 kBAdobe PDFView/Open

This item is protected by original copyright

A file in this item is licensed under a Creative Commons License Creative Commons

Items in the Repository are protected by copyright, with all rights reserved, unless otherwise indicated.

The metadata of the records in the Repository are available under the CC0 public domain dedication: No Rights Reserved

If you believe that any material held in STORRE infringes copyright, please contact providing details and we will remove the Work from public display in STORRE and investigate your claim.